There is an invisible threat that keeps the planet in suspense. Alexander Fleming himself warned about it before it even became a reality and, eight decades ago, in a prophetic speech after receiving the Nobel Prize in Medicine for discovering penicillin, he warned: “The time may come when anyone can buy penicillin online. the stores. Then there is the danger that the ignorant man can easily underdose himself and, by exposing his microbes to non-lethal amounts of the drug, make them resistant.” Fleming's omen came true and today, an epidemic of bacterial resistance is advancing freely across the globe, leaving behind a trail of deaths from infections that were once curable with antibiotics.
Bacterial resistance already kills around 1.2 million people in the world, a figure that, experts predict, will multiply by 10 in 2050. “We are in a critical situation in which we need the cooperation of the entire society to stop this pandemic: there are patients to whom we give the latest generation antibiotics and they die because those drugs do not work for them. And this is not going to slow down,” warns microbiologist Bruno González-Zorn, director of the Antimicrobial Resistance Unit at the Complutense University of Madrid and advisor to the World Health Organization (WHO) in this field. In Spain, an investigation in 130 hospitals revealed that these multi-resistant bacteria already kill 20 times more than car accidents: in 2023, more than 23,300 deaths were reported due to infections that do not respond to available antibiotics.
This species of superbacteria is increasingly attracting the attention—and concern—of all health authorities, but experts urge a forceful change of direction to reverse the dire projections in the short and medium term. “We find ourselves with a globalization of bacteria resistant to antibiotics. Before they attacked immunosuppressed patients in hospitals and now they have made the leap to the community, with tuberculosis and resistant sexually transmitted infections. Multi-resistant bacteria have spread,” explains María del Mar Tomás, researcher at the Biomedical Research Institute of A Coruña and spokesperson for the Spanish Society of Infectious Diseases and Clinical Microbiology.
The misuse or abuse of antibiotics, both at a health and veterinary level, is behind this health crisis that is growing unstoppably, in the heat of other external factors that fuel resistance, such as the absence of new families of antibiotics that reinforce the therapeutic arsenal. . Climate change has not helped either, adds Tomás, because “it favors the persistence of these multi-resistant bacteria.” And the Covid pandemic, despite being caused by a virus, has also collaterally caused an increase in the consumption of antibiotics in the hospital setting to respond to the secondary bacterial infections that often accompanied patients admitted due to the coronavirus.
Bacteria are, in the words of González-Zorn, “precious living beings with an incredible capacity for adaptation.” But that means that they have the resources and weapons to mutate their genetic information in order to overcome adversities – such as antibiotics – and colonize new ecosystems: they are capable of multiplying with resistance, but also of passing it on to other bacteria. No one is safe from these microbes, warns the scientist: “There are people who think that, since they do not take antibiotics, they will not have resistant bacteria. But we are all in the same boat. The bacteria does not stay in that person who takes antibiotics, it affects us all.”
Globalization, on the other hand, also helps to spread resistance. For example: a third of Spaniards who travel to India, where superbacteria are rampant, usually bring back with them, as carriers, multi-resistant strains. “They have no effects, but if they suffer an infection, it will be more difficult to treat. And they can transmit that bacteria to their environment,” explains Jordi Vila, microbiologist and director of the Antimicrobial Resistance Initiative at the Barcelona Institute for Global Health (ISGlobal), a center promoted by the “la Caixa” Foundation. González-Zorn agrees, in any case, that the key to these multi-resistant bacteria establishing themselves in a country will always depend on the local consumption of antibiotics: “A bacteria resistant to an antibiotic has an enormous advantage when there is that drug in the environment. When that antibiotic is not in the environment, sensitive bacteria also multiply.”
The WHO has under strict surveillance a handful of these microscopic enemies, the most dangerous and for which new antibiotics are urgently required. “The leader is still the Acinetobacter baumannii. It is the priority problem and pan-resistant strains have been found,” explains Vila. There are bacteria with the ability to overcome all available antibiotics.
And they are not isolated cases, González-Zorn laments: “Increasingly we are faced with the fact that we cannot resort to antibiotics to cure patients.” In practice, this means running out of therapeutic alternatives for these patients. “When the infection affects a member of the body, we are resorting to amputation to get rid of the infection. It sounds primitive, but it's what you do. In other cases, medical support is given to the patient to try to boost their immune system as much as possible so that it fights the infection,” she says.
Faced with such a dire scenario, authorities and scientists have conspired in the so-called One Health strategy, which consists of attacking the problem in several ways. “We have realized that resistant bacteria leave the hospital and we have found them in pets or wastewater, for example. So we have to fight them from inside and outside the hospital,” explains González-Zorn. Countries have begun to reduce the consumption of antibiotics in veterinary environments and rationalize their healthcare use to avoid new superbacteria and try, if possible, to reverse existing resistance—some bacteria become sensitive again when the antibiotic disappears from the environment for a time. . But there is still a long way to go. “Perhaps we will see a decrease in the slope of increasing resistances, although we will never be able to achieve zero resistances. It will continue to increase progressively, perhaps at lower levels, but we need new antibiotics,” Vila insists.
No new antibiotics are expected soon. Experts admit that the development of these drugs is not, in the eyes of the pharmaceutical industry, a profitable market and they propose incorporating economic incentives to once again boost their interest. In any case, they also maintain other avenues of research to find new therapeutic tools. For example, phage therapy, which are viruses capable of annihilating bacteria and which have already been tested for some infections. “There are banks of natural phages with which infections could be treated in combination with antibiotics. And if we do not find natural phages, they could be genetically designed or synthetic phages created,” says Tomás, who researches these microbial cocktails.
Prevention, however, remains the key and González-Zorn assures that there is still room for improvement here: “We self-medicate more than the rest of Europe, 5% of pharmacies give antibiotics without prescriptions and we must prescribe according to 2024 , not only to cure the patient, but to preserve the most modern antibiotics for when we really need them. We need more involvement and awareness.” The evolution of this health crisis will depend, to a large extent, on improving all of this globally, but everything is up in the air, admits the microbiologist: “It may happen that a pan-resistant bacteria spreads easily and has more mortality, but I don't think that will happen. . “I think this will continue to be a silent pandemic that will continue to advance little by little.”
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